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    Biliary Complications in 106 Consecutive Duct-to-Duct Biliary Reconstruction in Right-Lobe Living Donor Liver Transplantation Performed in 1 Year in a Single Center: A New Surgical Technique
    (Elsevier Science Inc, 2011) Kirimlioglu, V.; Tatli, F.; Ince, V.; Aydin, C.; Ersan, V.; Ara, C.; Aladag, M.
    Objective. Biliary complications remain a major source of morbidity after living donor liver transplantation (LDLT). Of 109 consecutive right lobe (RL)-LDLTs performed in 1 year in our institution, we present the biliary complications among 106 patients who underwent a new duct-to-duct anastomosis technique known as University of Inonu. Methods. Of 153 liver transplantations performed in 1 year from January to December of 2008, 128 were LDLTs including 109 RL-LDLTs. The others were left or left lateral grafts. All RL-LDLT patients were adults, all of whom except three included a duct-to-duct anastomosis. Results. All, but three, biliary reconstructions were completed with a surgical technique, so called UI, in which 6-0 prolene sutures were used. Nine bile leaks were seen in 106 recipients (8.49%) performed in a duct-to-duct fashion in a time period of 1 to 4 weeks. Seventeen patients (16.03%) posed bile duct stricture (BDS). Five patients had both. Although endoscopic stent placement and percutaneous balloon dilatation, 4 patients continued to suffer from BDS on whom a permanent access hepatico-jejunostomy (PAHJ) procedures were performed. Conclusion. We recommend a duct-to-duct biliary reconstruction because of its de facto advantages over other types of anastomosis provided the native duct is not diseased. After almost 2 years, the bile tract complication rate was 22.64%.
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    Endoscopic treatment of biliary complications after duct-to-duct biliary anastomosis in pediatric liver transplantation
    (Springer, 2019) Harputluoglu, M.; Demirel, U.; Caliskan, A. R.; Selimoglu, A.; Bilgic, Y.; Aladag, M.; Erdogan, M. A.
    Background Studies reporting outcomes of endoscopic treatment methods in children who underwent liver transplantation (LT) is very limited. We present our outcomes, as a high-volume transplant center where endoscopic methods are preferred as the first choice in the treatment of biliary complications in children. Methods Patients who underwent endoscopic retrograde cholangiopancreatography (ERCP) as the first treatment approach for biliary complications after LT between 2005 and 2017 were included. Clinical data included patient demographics, ERCP indications (stricture or leak), and treatment outcomes, including the need for percutaneous and surgical intervention. Results ERCP was performed in 49 patients who had a duct-to-duct anastomosis (38 living donor liver transplantation (LDLT), 11 deceased donor liver transplantation (DDLT)). The most common biliary complication was stricture. Our endoscopic success rate was 66.7% (18/27) and 75% (6/8) in LDLT and DDLT patients with stricture (p > 0.05), respectively. While our endoscopic success rate was 75% (3/4) in patients with leak alone after LDLT, it was 25% (1/4) in patients with leak and stricture in this group. The endoscopic success rate was 50% in two patients who had leak alone after DDLT. Conclusions ERCP should be considered as a preferential treatment option for the management of biliary complications in pediatric liver transplant patients with duct-to-duct anastomosis, as in adults.
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    Endoscopic treatment of biliary complications after living donor liver transplantation in a high volume transplant center in Turkey; a single-center experience
    (Univ Catholique Louvain-Ucl, 2018) Harputluoglu, M.; Aladag, M.; Demirel, U.; Bilgic, Y.; Dertli, R.; Erdogan, M. A.; Karincaoglu, M.
    Background and aim : Biliary complications are an important cause of mortality and morbidity after living donor liver transplantation (LDLT). We present our endoscopic treatment results after LDLT as a single center with high volume. Methods : Patients who underwent endoscopic retrograde cholangiopancreatography (ERCP) alter LDLT between 2005 and 2015 were included. Clinical data included patient demographics. ERCP indications (stricture or leak), and treatment outcomes, including need for percutaneous and surgical interventions. Results : ERCP was performed in 446 (39.2%) patients with duct-to-duct anastomosis of 1136 LDLT patients. The most common biliary complication was stricture +/- stone (70.6%, 315/446). Stricture and leak occurred in 60 (13.4%) patients. Only binary leak was found in 40 (8.9%) patients. Our endoscopic treatment success rate in patients with biliary stricture after LDLT was 65.1%. Overall endoscopic success rates in our patients were 55.0% in patients with both leak and stricture, and only leak. In all, our percutaneous transhepatic biliary interventions (P'f BI) and ERCP success rate was 90.6% in patients with biliary complications after LDLT. Conclusions : Endoscopic treatments are highly effective for biliary complications after LDLT. Effective use of percutaneous interventions in collaboration with endoscopic treatments significantly reduces the need for surgical treatment.
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    Endoscopic treatment of biliary complications after pediatric liver transplantation in a high volume transplant center in Turkey
    (Lippincott Williams & Wilkins, 2018) Harputluoglu, M. M. M.; Aladag, M.; Bilgic, Y.; Erdogan, M. A.; Caliskan, A. R.; Selimoglu, A.; Demirel, U.
    [Abstract Not Available]
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    ESTIMATION OF HEPATITIS C COSTS IN TURKEY VIA EXPERT OPINION: DELPHI PANEL
    (Elsevier Science Inc, 2014) Ormeci, N.; Akarca, U.; Aladag, M.; Balik, I; Kadayifci, A.; Kalayci, C.; Kaymakoglu, S.
    [Abstract Not Available]
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    Galectin-1 as a potential diagnostic biomarker in polycystic ovary syndrome
    (Verduci Publisher, 2023) Aladag, H.; Kiran, T. R.; Inceoglu, F.; Yildirim, E.; Yaprak, B.; Karabulut, A. B.; Aladag, M.
    OBJECTIVE: This study was aimed at comparing the routine laboratory pa-rameters and Galectin-1 levels of control and polycystic ovarian syndrome patients.PATIENTS AND METHODS: 88 patients di-agnosed with polycystic ovary syndrome and 88 healthy controls were considered for the study. Age groups of the patients ranged from 18 to 40. Serum TSH, Beta HCG, glucose, insulin, HO-MA-IR, Hb1A1c, triglyceride, total cholesterol, LDL FSH, LH, E2, prolactin, testosterone, SHBG, DHESO4, HDL, Gal-1 levels were analyzed for each subject.RESULTS: FSH, LH, LH/FSH, E2, prolactin, testosterone, SHBG, DHESO4, HDL and Gal -1 values of the subjects included in the study were statistically significantly different between the groups (p<0.05). Gal-1 and DHESO4 showed a strong positive connection (p=0.05). The sen-sitivity of Gal-1 level in PCOS patients was cal-culated as 0.997 and specificity as 0.716.CONCLUSIONS: High levels of Gal-1 in PCOS patients suggest that it increases due to overex-pression in response to inflammation.
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    Is the use of Tenofovir Dipivoxil fumarate effective and safe in preventing vertical transmission in pregnant women with chronic HBV with high viral load?
    (Verduci Publisher, 2023) Aladag, H.; Aladag, M.
    OBJECTIVE: In our country, transmission from mother to baby is the most common form of transmission of viral hepatitis B. A high viral load in the mother and HBeAg positivity pose the greatest risk of transmission from mother to baby. The best way to pre-vent this is to try to eliminate the viral load in the mother by using a strong antiviral such as prenatal TDF in mothers with a high viral load during pregnancy. This study aimed to evaluate the efficacy and safety of TDF in pregnant women with high viral load.PATIENTS AND METHODS: Seventy patients with hepatitis B e-antigen positive and negative were included in the retrospective study conducted in our clinic. In 35 cases, pregnant women with HBeAg (+) positive chronic HBV and HBV-DNA levels of 107 copies/mL were be-tween 18 and 27 weeks of pregnancy. The preg-nant women took 300 mg of TDF per day. There were 35 untreated HBeAg-negative, chronic HBV patients in the control group. Babies born to HBeAg-positive and HBeAg-negative mothers are given an initial dose of 200 IU of hepatitis B immune globulin (HBIG) and 20 g of recombi-nant hepatitis B vaccine in the first 12 hours af-ter birth, followed by 4, 8, and 24 weeks. HBsAg and HBV-DNA findings were examined in new-born serum 28 weeks after birth.RESULTS: Postpartum 28 weeks, none of the babies born to HBeAg-positive mothers treated with TDF had HBsAg positivity, while 3.5% of babies born to HBeAg-negative mothers and not treated with TDF had HBsAg positivity and immunoprophylaxis failure. There was no statistically significant difference between the treatment and control groups regarding maternal height, weight, gestational age, or congenital malformations (p<0.05). There was no signifi-cant difference between the side effects seen in mothers. In the examination performed at the 28th week postpartum, a statistically signifi-cant decrease in HBV-DNA levels was observed in mothers who received TDF treatment com-pared to those who did not (88.5%) (p<0.05). In 31 of the 35 patients receiving TDF treatment, ALT was reported to be normalized in 25 of the 35 patients who did not receive TDF treatment (p<0.05).CONCLUSIONS: It has been observed that the use of TDF, which has a strong efficacy and high barrier, in the second and/or third trimester of pregnancy reduces transmission rates without causing side effects in both the mother and the newborn, thereby preventing vertical transmission of viral hepatitis B from the mother to child.
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    Recurrence and occurrence of hepatocellular carcinoma following ledipasvir and sofosbuvir treatment for chronic hepatitis C in patients with advanced liver disease: Turkish multi-center early access program
    (Elsevier Science Bv, 2018) Idilman, R.; Demir, M.; Aladag, M.; Kaymakoglu, S.; Erol, C.; Cavus, B.; Iliaz, R.
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    The relationship between the use of nucleos(t)ide analogs and metabolic parameters in patients with chronic hepatitis B
    (Verduci Publisher, 2023) Yakut, A.; Aladag, M.
    - OBJECTIVE: In the treatment of chronic hepatitis-B (CHB), although viral rep-lication load is reduced with the use of nucle-os(t)ide analogs, the risk of cirrhosis and hepa-tocellular carcinoma (HCC) remains. We aimed to investigate the relationship between metabol-ic syndrome (MetS) and CHB of nucleos(t)ide an-alogs, which are effective in mortality-morbidity. PATIENTS AND METHODS: In patients who applied to the gastroenterology outpatient clin-ic between 2021 and 2022, we compared inac-tive HBsAg-positive patients who did not receive treatment with nucleos(t)ide analogs [entecavir (ETV), lamivudine (LAM), tenofovir disoproxil fu-marate (TDF), tenofovir alafenamide (TAF)] and medical treatment. Demographic characteristics of the patients were recorded. Lipid profile, He-moglobin A1c (HbA1c), and HOMA-IR were re-corded. The presence of hepatosteatosis was graded ultrasonographically. APRI, Forns Index, and FIB-4 score, which are indicators of non-in-vasive liver fibrosis, were evaluated. RESULTS: Of the 265 patients, 55.5% (n=147) were males and 44.5% (n=118) were females. The ages of the participants ranged from 18 to 80, with a mean age of 46.54 +/- 14.03. It was observed that 62.3% (n=165) of the cases received medical treat-ment. When the drugs used by those receiving medical treatment were examined, 70.3% (n=116) TDF, 6.1% (n=10) TAF, 3% (n=5) LAM, and 20.6% (n=34) ETV, LDL, HDL, and total cholesterol mea-surement values of those who received medical treatment were lower, while HOMA-IR values were higher compared to those who did not receive the medical treatment. While the HbA1c value of the patients using ETV was found to be high, the liv-er stiffness indicator scores of those using TDF were found to be significantly higher. CONCLUSIONS: In this study, in patients with CHB, it has been shown that medical treatment also affects MetS parameters.